Dr. Pembroke’s Clinic – Trepanning Pt. 3 – Defiance and Demonstration

London, 1872

Doctor-Chirurgeon J. D. Pembroke

My name is Doctor-Chirurgeon J. D. Pembroke. This is Part 3 of the study of trepannation. Part 1 and part 2 are available for your perusal.

As the art of surgery progresses, we see increased skill employed and ever more subtle intrusions into the dermal layers, resulting in fewer scars and diminished bodily disfigurement. Not so with trepanning. The scar is horrendous, the cranium is forever fractured, surrounding hair is lost almost entirely and the patient rarely survives. That said, I believe that humans concern themselves too prominently with outward appearance, or living. Cowards unwilling to put aside vain notions of bodily uniformity, (as well conscious existence) will never be adequate subjects for my experiments anyway. How are we expected to move into a glorious age of unfettered discovery when principles of open research are heavily opposed by people exhibiting glaringly inconsistent value structures and spurious morals?

Indeed. Forgive my outburst and soap-box-style promulgation.

Personal bias aside, while the procedure is intensely painful, even with the application of chloroform, nitrous oxide or ether, it is enormously helpful in resolving a number of ailments including removal of tumors, releasing of pressure, and also to perform experiments on the brain itself. The survival rate stands at around 10% in the average hospital, meaning that it is looked upon as a failed procedure. The rationale for that belief is flawed because of my following arguments:

The appalling hospital conditions despite stringent antiseptic conditions makes even a successful procedure doomed due to suppuration (infection of the wound)

The procedure is only ever applied to patients for whom trephannation is a last-ditch effort – I however work on physiologically healthy patients (despite a lack of symptoms)

I work entirely on the dregs of society: criminals, prostitutes, immigrants, the socially bereft, therefore such human losses are hardly a detriment to the forward progress of our species.

The finest of European hospitals

This means that my trepanning procedures have a survival rate of upwards of 75%, a significant difference from those who merely seek to improve the likelihood of survival with critically ill, affluent patients, from whom modern medicine has little to learn.

Recently I was able to perform my clinic before a live audience during a recent excursion to the center of the Earth (colloquially known as Teslacon‘). I was able to perform two surgeries; one utilizing a modified ‘faith’ healing technique of Philippine origin, the other, the well-studied trepanning procedure as described in historical context within the previous two essays. All the audience that observed the clinic appeared to be quite… entertained.

I will be describing my procedure in full below:

My Hungarian patient – symptoms irrelevant

Subject 454#B, a young lady of Hungarian descent, had been complaining of headaches and migraines (at least I think she was, I simply could not understand the backward eastern-European garble they term a language. Why they don’t all speak English, I will never know). My immediate conclusion was cephalagia due to pressure on the brain following some presumed trauma and I prescribed the immediate opening of the skull via craniotomy.

Some physicians or the more educated of my readers might question my rapid escalation to such a severe treatment. My answer to this: they shouldn’t question. I know what I’m doing and they do not. Besides, nobody will miss a Hungarian immigrant. It is 1872 after all.

After the subject was secured in the chair, the procedure began. Rather than employing the multiple legged trephining contraptions, I instead utilized a skull-harness of my design to accurately direct the movement of the trepanning tool, itself a personally modified and heavier version of the crown-cylinder design. The harness was attached, moderate opiates applied, although the subject, being of foreign origin, was almost certainly already drunk.

Crown head cylinder trepan – effective, if painful

Rather than perform the separate procedure of incising the supra-dermal level of skin to expose the skull, I chose the expedient approach of removing the skin at the same time as penetrating the skull itself. This would create skin tearing and a great deal more pain – but I bring your attention back to the likely prior occupation of my subject and the consequential and proper dismissal of usual concerns for all of my, er, I mean, this particular patient in question.

A loud cracking noise was heard as the trepan entered the skull and penetrated the dura-mater. This was likely due to an insufficiently sharpened trepanning tool. My assistant will receive the Christmas bonus of lobotomization as recognition of his sloppy preparatory work.

Forgive my slight smile – not that this is fun, or anything

Due to the fracturing of the ‘bone medallion’, it was necessary to remove the pieces using forceps. Unfortunately much of the fractured material had already begun to migrate between the membrane and the cranium. Despite the building up of fluid and excess quantities of blood, I was able to retrieve the fragments, which were placed in a suitable bowl.

It was my understanding that I was exposing the sections of the brain responsible for general motor functions, but it was to my surprise that I realized I had actually been able to access brain regions responsible for motor functions specific to facial expression. My notes to future surgeons – do not dip ones thumb directly into the brain itself – or do so, but expect interesting results.

I know it’s in here somewhere…

It was at this moment that I terminated the clinic (please refer to the film capture footage below). I realized that perhaps I had gone beyond the realms of head-aches and migraines, and while my patient would surely not survive, my manipulation of her facial expressions and perhaps the core feelings themselves, would surely yield greater discoveries at later times. This itself is the underlying factor of my mission as a surgeon – to better understand the human mind, both psychologically and physiologically – and to improve upon the human machine. This work will continue.

(Partial photo credit and full video credit to DarkCatt Studios – thank you for the amazing work)